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To speed up admissions, address virtual capacity’
As the ED staff at Lehigh Valley Hospital in Allen-town, PA, have learned, it’s how you respond to benchmarking data that determines success. For example, to speed up admissions, it was necessary to address virtual capacity issues.
This, in turn, required cooperation by the entire hospital, says Michael Weinstock, MD, FACEP, chairman of the department of emergency medicine.
"You can improve all the ED processes you want, but if there is no buy-in from the organization where the beds are, you will go nowhere," he asserts. "Regardless of how many benchmarks you do, [you won’t succeed] until you eliminate the virtual capacity problems that exist in the organization."
By virtual capacity,’ Weinstock is referring to arcane processes that make inpatient beds unavailable for occupancy — not just in the ED. "In some places, it takes 3.5 hours to clean a bed; in this hospital, it takes 30 minutes," he declares.
While these improvements were initiated by the ED, middle and upper hospital management supported the ED with assistance and resources, Weinstock notes. "This included the time and focus of middle management and upper management that were brought to the table and provided us with staff from organizational development and from all areas of the hospital that impacted length of stay and patient care," he explains,
"Three years ago, we recognized the [capacity] problem and tried to address it with specific changes in the ED, but we were unsuccessful," adds Richard MacKenzie, MD, FACEP, vice chairman of the department of emergency medicine at Lehigh Valley. "That spurred us to get involved with the hospital network in terms of bed capacity."
Every hospital has a supply and demand curve, he explains. "Our demand for hospital beds peaks at around 10 a.m., but capacity, prior to all our work, peaked at around 5 p.m., so we had a supply-demand mismatch."
What was required was moving the capacity curve earlier in the day, which was dependent on hospital-wide changes. "In the past, we would routinely go on diversion many afternoons because we were told by bed management there were no beds, and we would not get any," MacKenzie recalls. "But there really was capacity, just not enough staff to clean the beds and no priority [on making them available]. When you remove those barriers, you move the patients better."
The hospital responded with two express admit units. One is for the office-based medical staff members who have a direct admission and for whom there will be potential bed availability in two hours. That patient can then go to the express admit unit and be worked up in accordance with the physician’s orders; and when a bed becomes available, the patient can go upstairs.
The second express admit unit specifically is for the ED patient who is admitted and awaiting bed placement. These patients can be moved to the ED express admit unit, making that bed available in the ED, and that patient then will be moved upstairs, MacKenzie explains. In the past, he notes, if a doctor called and wanted to admit a patient at 9 a.m., they would hold a medical-surgical bed and the patient might not arrive until 5 p.m. "Now, when the patient arrives, we start looking for a bed," says MacKenzie.
In addition, it was discovered that the hospital’s 40-bed pre-surgical area was packed at 7-10 a.m., but emptied out at noon, so "40 beds were just sitting there until 6 a.m.," he adds. "Now, at 2 p.m., these beds are used to relieve the backlog in the ED, and we are using no additional space resources."
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